Tryngolza (olezarsen) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of FCS confirmed by either:
• 1. genetic test demonstrating biallelic pathogenic variants in at least one gene causing FCS (LPL, GPIHBP1, APOA5, APOC2, or LMF1) OR
• 2. genetic test results inconclusive AND member meets one of the following: FCS score ≥ 10 OR NAFCS score ≥ 45 OR history of pancreatitis OR history of eruptive xanthomas OR history of lipemia retinalis
• fasting triglyceride level ≥ 880 mg/dL
• Tryngolza will be used in combination with diet

Reauthorization criteria

• documentation of improvement in triglycerides from baseline

Approval duration

initial 6 months, reauthorization 12 months